内容紹介
Summary
We report a case of recurrent pancreatic cancer in the remnant pancreas after pancreatoduodenectomy(PD)that was successfully treated by surgical resection. A woman in her 70s who was treated for multiple lung metastases of breast cancer was referred to our hospital because of obstructive jaundice. A low-density area in the pancreas head(19 mm in diameter)and dilatation of the main pancreatic duct were observed on abdominal CT. She was diagnosed with pancreatic head cancer and underwent PD. Twenty months after PD, abdominal CT revealed a tumor in the pancreas tail, and she started receiving chemotherapy containing gemcitabine(GEM)for the diagnosis of recurrent pancreatic cancer in the remnant pancreas. Twelve months after the induction of chemotherapy, we performed surgical resection of the tumor(total pancreatectomy). The pathological diagnosis was moderately differentiated adenocarcinoma, which was similar to the primary lesion, and the tumor was confirmed as recurrence of pancreatic cancer. Although she died of multiple lung metastases of breast cancer 62 months after the total pancreatectomy, the recurrence of pancreatic cancer was not observed without adjuvant therapy during that time.
要旨
症例は70歳台,女性。乳癌多発肺転移に対する治療中に閉塞性黄疸が出現し,当院を紹介受診した。膵頭部に19 mm大のSOLを認め,膵癌の診断で膵頭十二指腸切除術を施行した。病理組織診断は浸潤性膵管癌,進行度はT3N1M0,StageⅡBであった。術後20か月目のCTで膵尾部にSOLが出現し,残膵再発の診断で化学療法を12か月間施行したところ他に新たな再発病巣の出現はなく,乳癌の肺転移にも増悪がみられなかったため初回切除から2年10か月目に残膵全摘術を施行した。病理組織像は初回切除時のものと類似しており,残膵再発と診断した。残膵全摘後は,乳癌多発肺転移に対するホルモン療法のみ施行していたが,残膵全摘後5年2か月目に乳癌の増悪により死亡した。その間,膵癌の再々発は認めなかった。本症例は,膵癌切除後の残膵再発に対して残膵切除を施行し,長期生存が得られたまれな症例と考えられた。
目次
We report a case of recurrent pancreatic cancer in the remnant pancreas after pancreatoduodenectomy(PD)that was successfully treated by surgical resection. A woman in her 70s who was treated for multiple lung metastases of breast cancer was referred to our hospital because of obstructive jaundice. A low-density area in the pancreas head(19 mm in diameter)and dilatation of the main pancreatic duct were observed on abdominal CT. She was diagnosed with pancreatic head cancer and underwent PD. Twenty months after PD, abdominal CT revealed a tumor in the pancreas tail, and she started receiving chemotherapy containing gemcitabine(GEM)for the diagnosis of recurrent pancreatic cancer in the remnant pancreas. Twelve months after the induction of chemotherapy, we performed surgical resection of the tumor(total pancreatectomy). The pathological diagnosis was moderately differentiated adenocarcinoma, which was similar to the primary lesion, and the tumor was confirmed as recurrence of pancreatic cancer. Although she died of multiple lung metastases of breast cancer 62 months after the total pancreatectomy, the recurrence of pancreatic cancer was not observed without adjuvant therapy during that time.
要旨
症例は70歳台,女性。乳癌多発肺転移に対する治療中に閉塞性黄疸が出現し,当院を紹介受診した。膵頭部に19 mm大のSOLを認め,膵癌の診断で膵頭十二指腸切除術を施行した。病理組織診断は浸潤性膵管癌,進行度はT3N1M0,StageⅡBであった。術後20か月目のCTで膵尾部にSOLが出現し,残膵再発の診断で化学療法を12か月間施行したところ他に新たな再発病巣の出現はなく,乳癌の肺転移にも増悪がみられなかったため初回切除から2年10か月目に残膵全摘術を施行した。病理組織像は初回切除時のものと類似しており,残膵再発と診断した。残膵全摘後は,乳癌多発肺転移に対するホルモン療法のみ施行していたが,残膵全摘後5年2か月目に乳癌の増悪により死亡した。その間,膵癌の再々発は認めなかった。本症例は,膵癌切除後の残膵再発に対して残膵切除を施行し,長期生存が得られたまれな症例と考えられた。